Registration for Lil Bobcat Basketball Camp

Please fill out the form below to register for Lees-McRae's 2013Lil' Bobcat Basketball Camp, scheduled for June19-21. The camp puts an emphasison instruction in all facets of the game, as wellas station work and 3-on-3 competition.

The camp is open to both boys and girls in grades 3-6, andwill run from 9 a.m. to 12 p.m. The cost of this camp is $50 perplayer. Each camper will receive a free T-Shirt.

 Walk-ins welcome - registration begins at 8a.m. on first day of camp.

For more information, please contact head women's basketballcoach Michele Williams by phone at (828) 898-2482, or assistantcoach Ryan Riedel by phone at (828) 898-3431 or by email atriedelr@lmc.edu.



Personal Information

Email address *
First name *
Last name *
Address 1
Address 2
City
State
ZIP Code
Home Phone
Alternate Phone
Birthdate
Shirt Size *
Covered under Medical Insurance? *
If yes, please specify your provider and policy information in the fields below
  Yes
  No
Insurance Provider *
Enter N/A if not applicable
Policy Holder Name *
Enter N/A if not applicable
Policy Number *
Enter N/A if not applicable


Custodial Parent/Guardian Information

Registrant is in the custody of
If provided options do not apply, complete the next field
  Both parents
  Mother only
  Father only
Other
Mother/Guardian Name
Daytime Phone
Work Phone
Father/Guardian Name
Daytime Phone
Work Phone


Medical Information

Please list medications *
Please list allergies *
List any known physical limitations or concerns that we should be aware of


Emergency Contact Information (other than guardian)

Full name
Home Address 1
Home Address 2
City
State
Zip
Primary Phone
Alternate Phone
Relationship to camper

Waiver of Responsibility

I agree Lees-McRae College and its athletic department isreleased from liability in connection with medical treatment andunavoidable accidents. Lees-McRae CollegeLil' Basketball Camp also has my permission to usenecessary medical measures in the event of an emergency, for whichI will be financially responsible.

I fully understand the inherent risks involved in the activitiesmy child will be participating in for this basketball camp atWilliams Gymnasium. I accept all risks including those activitiespreliminary and subsequent to the activity.  

I do hereby further declare [provide child’s full name below] to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent their participation, with or without reasonable accommodation of any disability, in any of the activities and programs of the Lees-McRae College Lil' Bobcat Basketball Camp. I do hereby assume all responsibility for this child’s participation and activities, and his/her use of equipment in activities. *

Also, I give the Lees-McRae College women's basketball programpermission to utilize my child's photograph or likeness in camppromotional materials.

Parent or Guardian Electronic Signature *
Date *

PLEASE MAKECHECKS PAYABLE TO:

Lees-McRae Athletic Camps

PLEASE MAIL TO
OR BRING TO FIRST DAY OF CAMP CHECK IN:

Lees-McRae College Lil'Bobcat Basketball Camp
Attn: Michele Williams
PO Box 128
Banner Elk, NC 28604

 
* = required field